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General NPI Number Information
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NPI Number | 1932462611
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Entity Type | Individual
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Provider Name | RYAN SEAN DREIKORN CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 200 HAWTHORNE LN
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City | CHARLOTTE
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State | NC
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Zip | 28204-2515
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Country | US
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Telephone | 704-384-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 329 GRIFFITH AVE
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City | JOHNSTOWN
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State | PA
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Zip | 15909-1005
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Country | US
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Telephone | 814-322-4245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 088711
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License Number State | PA
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